Stroke Coordinator Boot Camp April 17 2015 Copyright

Stroke Coordinator Boot Camp April 17, 2015 © Copyright, The Joint Commission Preparing for Stroke Certification

Presenter Disclosure Information z. MJ Hampel Preparing for Stroke Certification z. Financial Disclosure: AHA Stroke Boot Camp 4 17 15 - 2 © Copyright, The Joint Commission No relevant financial relationship exists

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CSC 75 – 200 Primary Stroke Center 1000 – 1200 Acute Stroke Ready Hospitals 1200 - 1800 2012 Academic medical center, tertiary care facility 2003 Wide range of hospitals; standard stroke care; stroke unit; uses t. PA July 2 015 Rural hospitals; basic care; drip and ship; use teletechnologies AHA Stroke Boot Camp 4 17 15 - 4 © Copyright, The Joint Commission Models of Stroke Care

PSC CSC TOTAL 1060 85 1145 Indiana 22 1 23 Illinois 54 5 59 Michigan 29 3 32 Nebraska 13 0 13 USA < Data as of 4/8/15 > AHA Stroke Boot Camp 4 17 15 - 5 © Copyright, The Joint Commission Certified Stroke Centers By the Numbers

PSC vs. ASRH z Primary Stroke Center – Stabilize and provide emergency care for patients with acute stroke – Designated beds for acute stroke patients – Either admit or transfer to a CSC – Provide emergency care for patients with acute stroke – Does not have designated beds for stroke patients – Drip and ship – Use telemedicine technologies AHA Stroke Boot Camp 4 17 15 - 6 © Copyright, The Joint Commission z Acute Stroke Ready Hospital

z Small, rural Acute Care Hospital or Critical Access Hospital (~100 beds or less) z No designated stroke beds z Relationship with local EMS fostering communication from the field during transport and sharing educational opportunities z Use of stroke protocols and an acute stroke team to expedite the assessment and treatment of a patient presenting with a stroke z Teleconsult capability and transfer agreements with facilities that provide primary or comprehensive stroke services z The ability to administer intravenous thrombolytics, if needed, prior to transferring the patient to a facility that provides primary or comprehensive stroke services AHA Stroke Boot Camp 4 17 15 - 7 © Copyright, The Joint Commission Characteristics of an ASRH

Advanced Certification Model Structure Standards + program specific requirements Process Outcome Clinical Practice Guidelines Standardized Performance Measures AHA Stroke Boot Camp 4 17 15 - 8 © Copyright, The Joint Commission Quality & Safety of Care for Patients

Structure: ASRH Requirements AHA Stroke Boot Camp 4 17 15 - 9 © Copyright, The Joint Commission z. Initial Assessment z. Telemedicine z. Transfer Protocol z. Staff Education z. Performance Measurement

z Performed by physician, nurse practitioner or physician assistant within 15 minutes of arrival z Includes NIHSS, CT/MRI, blood glucose test and dysphagia screen (prior to oral intake) z 24/7 access to z Stroke expertise, including consultation for IV-thrombolytic therapy z CT/MRI, lab tests, ECG, and chest x-ray WHEN ORDERED. Results available within 45 minutes (60 minutes for MRI) AHA Stroke Boot Camp 4 17 15 - 10 © Copyright, The Joint Commission ASRH Initial Assessment

z. Can provide informed consultation to ED practitioners, including evaluation of images z. Telemedicine/teleradiology equipment is onsite z. Telemedicine link is initiated within 20 minutes of when it is deemed necessary AHA Stroke Boot Camp 4 17 15 - 11 © Copyright, The Joint Commission ASRH Telemedicine

z. Agreement with one PSC or CSC z. Transfer IV-thrombolytic and neurosurgical patients z. Patients should leave the hospital within 2 hours of ED arrival or when medically stable z. Written protocol includes communication and feedback from receiving facility AHA Stroke Boot Camp 4 17 15 - 12 © Copyright, The Joint Commission ASRH Transfer Protocol(s)

z. Members of core stroke team receive at least 4 hours of stroke education annually z. ED staff (not including physicians) participate in 2 stroke educational activities per year z. Makes educational opportunities available to prehospital personnel AHA Stroke Boot Camp 4 17 15 - 13 © Copyright, The Joint Commission ASRH Staff Education

z. Monitor ability to administer t-PA within 60 minutes z. Monitor t-PA complications including symptomatic intracerebral hemorrhage and serious life-threatening systemic bleeding z. Committee meets twice a year to evaluate protocols and practice patterns AHA Stroke Boot Camp 4 17 15 - 14 © Copyright, The Joint Commission ASRH Performance Measurement

Additional Requirements for ASRH Topic Standard Number Stroke team log DSPM. 3, EP 2 a Stroke registry DSPM. 3, EP 2 b AHA Stroke Boot Camp 4 17 15 - 15 © Copyright, The Joint Commission Relationship with EMS DSPR. 3, EP 4

z Current evidence-based guidelines are embedded in the ASRH standing orders. z Evaluated thru patient tracer activity z Most frequently-cited requirement for improvement: 31% of reviews in 2014 cited for not delivering care through the use of CPGs z On-line resources: – American Heart Assn at www. heart. org – National Guideline Clearinghouse at www. guideline. gov AHA Stroke Boot Camp 4 17 15 - 16 © Copyright, The Joint Commission Process: Clinical Practice Guidelines

Outcome: Performance Measurement Criteria z. Four process or outcome measures to monitor on an ongoing basis z. Two of the measures must be clinical z. Other two measures can be clinical, administrative, utilization, or satisfaction AHA Stroke Boot Camp 4 17 15 - 17 © Copyright, The Joint Commission – Select from the universe of measures; or – Create your own measures

ASRH Performance Measurement z Potential choices include Door to needle time Turn around time for head CT/laboratory tests Practitioner response time to code stroke Patient complications Time to telemedicine link initiation Any of the stroke core measures z Resource for measures: http: //www. qualitymeasures. ahrq. gov/ AHA Stroke Boot Camp 4 17 15 - 18 © Copyright, The Joint Commission – – –

Pre • Gap analysis to standards and guidelines; resolution of any gaps • Apply 4 -6 months before desired review date • Data Collection Visit • 30 days advance notification of date • ASRH and PSC: One reviewer x one day • CSC: Two reviewers x two days Post • Data collection and submission • Intracycle conference call 12 months after visit • Apply for recertification Visit • Recertification visit occurs 2 years after initial visit • To be scheduled within 90 day window around anniversary date • 7 days advance notice of date AHA Stroke Boot Camp 4 17 15 - 19 © Copyright, The Joint Commission Certification Logistics

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z Builds the structure required for a systematic approach to clinical care z Reduces variability and improves the quality of patient care z Pushes you to look at yourself more closely z Creates a loyal, cohesive clinical team z Provides an objective assessment of clinical excellence z Differentiates clinical care in the marketplace z Promotes achievement to referral sources AHA Stroke Boot Camp 4 17 15 - 21 © Copyright, The Joint Commission Benefits of Certification

Contact Information AHA Stroke Boot Camp 4 17 15 - 22 © Copyright, The Joint Commission MJ Hampel, MPH, MBA Director, Clinical Services Certification The Joint Commission 630 -792 -5720 mhampel@jointcommission. org

The Joint Commission Disclaimer z These slides are current as of 4/17/15. The Joint Commission reserves the right to change the content of the information, as appropriate. z These slides are copyrighted and may not be further used, shared or distributed without permission of the original presenter or The Joint Commission. AHA Stroke Boot Camp 4 17 15 - 23 © Copyright, The Joint Commission z These slides are only meant to be cue points, which were expounded upon verbally by the original presenter and are not meant to be comprehensive statements of standards interpretation or represent all the content of the presentation. Thus, care should be exercised in interpreting Joint Commission requirements based solely on the content of these slides.